A case of chronic necrotizing pulmonary aspergillosis due toAspergillus nidulans

A 55-year old man without immunosuppression clinically showed a coin lesion in the right lower lung on the chest radiographs.Aspergillus nidulans was isolated and identified in both trans-bronchial lung biopsy specimen and resected tissue. The specimens revealed characteristics of chronic necrotizing pulmonary aspergillosis pathologically. Very few reports on cases of pulmonary aspergillosis due toA. nidulans exist, and we were not able to find any reports of similar cases. This case may be the first reported case of chronic necrotizing pulmonary aspergillosis due toA. nidulans.     

The respiratory function of blood in elderly and old age and the factors that determine it

Indices of pulmonary gas exchange, blood gases, the oxyhemoglobin dissociation curve, and intraerythrocytic metabolic parameters were analyzed in 62 apparently healthy elderly and senile subjects (60–92 years old) and 18 young healthy subjects (19–30 years old). PaO₂ was found to decrease in elderly and senile subjects. Arterial hypoxemia in old age is caused by an increase in the alveoloarterial PO₂ gradient, primarily as a result of the malcoordination of pulmonary ventilation and blood flow. A rightward compensatory shift of the oxyhemoglobin dissociation curve was observed, which was due to facilitated oxygen release in tissues owing to a pH decrease in erythrocytes (the Bohr effect). However, the facilitated oxygen release by oxyhemoglobin cannot compensate for the effect of factors deteriorating oxygen supply delivery to tissues, observed with aging, which is confirmed by the decrease in the partial pressure of oxygen in the venous blood of elderly and senile people, reflecting PO₂ in tissues.     

A pulmonary mass with invasion into the heart

We describe the case of a 58 year old woman who presented with bronchial atypical carcinoid found at surgery to invade the left atrium along the pulmonary veins. A right pneumonectomy and removal of a portion of the left atrium was performed. The patient made an excellent post operative recovery. Three years later she presented in acute respiratory failure secondary to local recurrence. This is first case described in which recurrence after resection of bronchial carcinoid metastatic to the heart is described.     

Family Physician

One hundred men and 100 women between the ages of 70 and 89 years were examined clinically and with pulmonary function tests to determine the prevalence and type of chronic obstructive bronchopulmonary disease in very old people. Rhonchi were present in 45% of the old men and 24% of the old women. Obstruction to air flow (FEV₁ < 60% of FVC) was demonstrated in 23% of the men and 6% of the women. Chronic bronchitis was present in 32% and 12% of the old men and women, respectively. Only five individuals, all men, showed emphysema as defined by significant obstruction to air flow with a low diffusing capacity. In old people there was a relationship between smoking, chronic cough and obstruction to air flow.     

Intimal pulmonary artery sarcoma presenting as dyspnea: case report

Background

We report a case of pulmonary sarcoma which is a rare cause of the common symptom of dyspnea.

Case presentation

A fifty-one year old previously healthy male presented to the emergency room with complaints of dyspnea on exertion. A cardiac workup including an exercise stress test was negative but an echocardiography showed pulmonary stenosis. Cardiac MRI showed a large mass extending from the pulmonic valve to both the right and left pulmonary arteries suggestive of sarcoma. A complete resection and repair of the pulmonary artery was done and adjuvant chemotherapy with doxorubicin and ifosfamide was recommended. The patient is currently disease free after eighteen months.

Conclusion

Pulmonary artery sarcomas are a difficult diagnosis. The diagnosis may remain elusive for some time until the proper imaging techniques are utilized to make a diagnosis. Earlier and accurate diagnosis may lead to earlier interventions and improve survival.

     

Evaluation Before Thoracotomy

When a thoracotomy is being considered, the physician must first determine whether the lesion is potentially resectable. However, an equally important decision is whether the patient can tolerate pulmonary resection if there are other serious underlying medical problems. In any patient with signs or symptoms of pulmonary disease, a spirogram, arterial blood gas study and electrocardiogram should be done as part of the routine preoperative evaluation. The detection of abnormal pulmonary function should prompt preoperative institution of respiratory care to optimize maximally a patient''s cardiorespiratory status before operation. If any of several indicators of a high risk of postoperative cardiopulmonary problems are found, split pulmonary function studies should be done to determine whether the lung remaining after resection will have adequate ventilation and perfusion. Xenon radiospirometry is preferable to bronchospirometry and right heart catheterization because of its noninvasiveness. Resection should not be undertaken in the presence of a predicted postoperative forced expiratory volume in one second (FEV₁) less than 0.8 liter, an arterial carbon dioxide partial pressure (PaCO₂) greater than 45 mm of mercury or Xenon scans which show poor ventilation/perfusion (˙V/˙Q) matchup in what would be the remaining lung after resection. A case is reported which shows the value of this approach to preoperative evaluation in determining the risk of postoperative problems.     

The two types of alpha cells during the development of the guinea-pig pancreas

Summary The prenatal and postnatal development of the two types of pancreatic A cells was examined in guinea-pigs. The A₁ and A₂ cells appeared at about the same time and were first seen in 26 days old fetuses, while B cells could not be recognized earlier than on the 39th day of intrauterine life. In all age groups examined with quantitative methods (65 days old fetuses to 9 months old guinea-pigs) the proportion of parenchyma in the pancreatic gland appeared higher in the cauda than in the caput. In the 3 months and 9 months old animals the proportions of the different types of islet cells were also higher in cauda than in caput. In each case the total weights of the A₁, A₂ and B cell fractions showed a similar growth rate relative to that of the body weights. The results are discussed in the light of previous observations in man and rat.Supported by the United States Public Health Service (AM-05759-05), the Swedish Medical Research Council (12X-562-02; 12X-109-03) and the Medical Faculty of Uppsala.     

Pulmonary oxygen toxicity: Lack of tolerance of mice of various ages

Prolonged continuous exposure of adult (3–4 months) and old (21 months) mice to hyperoxia did not lead to significant changes in the activities of superoxide dismutase and catalase in liver or blood. Lung superoxide dismutase activity increased by 25% during initial exposure to 100% O₂, but then fell progressively to below control level. Exposure of mice to 60% or 80% O₂ increased their susceptibility to further exposure to 100% O₂. The results clearly show that both adult and old mice are incapable of coping with the high oxygen environment and that antioxidant enzyme induction and the associated partial protection from pulmonary O₂ toxicity are not the general rule in mammalian lung exposed to subtoxic oxygen levels.     

Detection of an alteration of the α2 gene in a patient with chronic lung disease and serum α2 deficiency

Summary ₂-Macrpglobulin (A2M) is a major human plasma protease inhibitor capable of inhibiting most endopeptidases tested so far. In the case of the other major plasma protease inhibitor, ₁-antitrypsin, genetically determined deficiency states are known to increase the risk of chronic obstructive pulmonary disease (COPD) 20- to 30-fold in affected individuals. No defects of the A2M gene have been described as yet, but A2M may play a role in the regulation of protease activity in the lung, especially with respect to those proteases not inhibited by ₁-antitrypsin. We report here the molecular genetic detection of an alteration of the A2M gene in a patient with serum A2M deficiency and chronic lung disease since childhood. The alteration involves restriction sites detected with 10 different enzymes and is most probably caused by a major deletion or rearrangement of the gene. Nine of the restriction enzymes used detected no polymorphisms in 40 healthy control subjects and 39 COPD patients. The polymorphism detected in this patient with the enzyme PvuII was different from another described previously, and was found in this patient only. The patient is heterozygous for an alteration in the A2M gene; this may be responsible for his serum A2M deficiency and may be relevant to the early onset of pulmonary disease in his case.     

A solitary bronchial papilloma with unusual endoscopic presentation: case study and literature review

Background

Pulmonary rehabilitation is known to be a beneficial treatment for COPD patients. To date, however, there is no agreement for how long a rehabilitation program should be implemented. In addition, current views are that pulmonary rehabilitation does not improve FEV₁ or even slow its decline in COPD patients. The aim of the study was to examine the efficacy of a 3 year outpatient pulmonary rehabilitation (PR) program for COPD patients on pulmonary function, exercise capability, and body mass index (BMI).

Methods

A matched controlled trial was performed with outcome assessments evaluated at 6, 12, 18, 24, 30, and 36 months. Eighty patients with moderate to severe COPD (age 63 ± 7 years; FEV₁ 48% ± 14) were recruited. The control group received standard care only, while in addition, the case study group received PR for duration of three years. These groups were matched for age, sex, BMI, FEV₁% and number of pack-years smoked.

Results

The decline in FEV₁ after the three years was significantly lower in the PR group compared to control, 74 ml versus 149 ml, respectively (p < 0.001). Maximal sustained work and endurance time improved after a short period of PR and was maintained throughout the study, in contrast to the control group (p < 0.01). A decreased BMI was noted in the control group after three years, while in the PR group a mild improvement was seen (p < 0.05).

Conclusion

Three years of outpatient pulmonary rehabilitation resulted in modifying the disease progression of COPD, as well as improving physical performance in these patients.     

A1 adenosine receptor signaling reduces Streptococcus pneumoniae adherence to pulmonary epithelial cells by targeting expression of platelet‐activating factor receptor

Extracellular adenosine production is crucial for host resistance against Streptococcus pneumoniae (pneumococcus) and is thought to affect antibacterial immune responses by neutrophils. However, whether extracellular adenosine alters direct host–pathogen interaction remains unexplored. An important determinant for lung infection by S. pneumoniae is its ability to adhere to the pulmonary epithelium. Here we explored whether extracellular adenosine can directly impact bacterial adherence to lung epithelial cells. We found that signaling via A1 adenosine receptor significantly reduced the ability of pneumococci to bind human pulmonary epithelial cells. A1 receptor signaling blocked bacterial binding by reducing the expression of platelet‐activating factor receptor, a host protein used by S. pneumoniae to adhere to host cells. In vivo, A1 was required for control of pneumococcal pneumonia as inhibiting it resulted in increased host susceptibility. As S. pneumoniae remain a leading cause of community‐acquired pneumonia in the elderly, we explored the role of A1 in the age‐driven susceptibility to infection. We found no difference in A1 pulmonary expression in young versus old mice. Strikingly, triggering A1 signaling boosted host resistance of old mice to S. pneumoniae pulmonary infection. This study demonstrates a novel mechanism by which extracellular adenosine modulates resistance to lung infection by targeting bacterial–host interactions.     

An Imported Case of Blastomyces Dermatitidis Infection in Mexico

Blastomycosis is an acute or chronic primary infection of the respiratory system, endemic in North America (United States of America and Canada), Africa and Asia. We report a case in Mexico, in a three years old child who had been born in California and lived in Chicago, U.S.A. The patient presented pulmonary symptoms prior to development of a skin ulcer. Blastomyces dermatitidis was identified by mycological and molecular procedures. The patient was successfully treated with amphotericin B, oral ketoconazole and itraconazole.     

Apropos of a case of lesional pulmonary edema advancing to fibrosis with cartilage metaplasia

The non-hemodynamic pulmonary oedema by increase alveolo-capillary permeability or Adult Respiratory distress Syndrome (ARDS), has many causes and determine an acute insufficiency respiratory who needed mechanic ventilation. It can above all progressing to interstitial fibrosis after deadly. The writer present lesional pulmonary oedema case which evolved to fibrosis in a 17 old patient. This patient has been operated for duodenal ulcer with bi-vagotomy and antrectomy and presented a post operatory shock. The particularity of this observation is The fibrosis evolution to an cartilaginous metaplasia. The lesional pulmonary oedema has usually serious prognosis because the mortality is from 50 to 80% in the literature review.     

Pulmonary nodules: An unusual onset of HIV infection belatedly diagnosed

BackgroundCryptococcosis is a generally systemic and potentially lethal fungal infection. Although HIV infection is a predisposing condition, especially if the CD₄₊ lymphocyte count is less than 100 cells/mm³, other forms of immunosuppression may be associated with this opportunistic fungal condition, such as prolonged steroid therapy or solid organ transplantation. Pulmonary presentation must be included in the differential diagnosis of pneumonia or pulmonary neoplasia in the immunosuppressed patient.Case reportWe report a case of pulmonary cryptococcosis in a non-diagnosed HIV patient. In a 44 year-old male suffering from dyspnea and chest pain the image of a pulmonary nodule was observed in a radiological finding. In the histopathological study, intracellular structures suggestive of fungal conidia, and morphologically compatible with Cryptococcus, were observed. HIV serology and cryptococcal antigen detection in serum were requested, given the possibility of cryptococcosis. Cryptococcus neoformans var. grubii was isolated from the culture of the pulmonary biopsy. The patient was finally diagnosed with pulmonary cryptococcosis and HIV-1 infection. With a proper antifungal treatment the patient evolved satisfactorily.ConclusionsThe best strategy to avoid opportunistic infections such as cryptococcosis in HIV-infected patients consists of an early diagnosis and a highly active antiretroviral treatment. In our case, the diagnosis of a pulmonary infection by C. neoformans var. grubii allowed a late diagnosis of HIV-1 infection.     

An increased carbon dioxide production in transient hypoxia in healthy subjects at rest

Indices of pulmonary gas exchange and heart rate (HR) have been measured in 24 healthy subjects not adapted to hypoxia after hypoxic aerial mixture (HAM) (17, 15, 13 vol % of oxygen) respiration for 15 min. Using group data analysis, it has been shown that hypoxia under the conditions of inhalation of 17 and 15 vol % of O₂ caused no significant changes. Hypoxia under the conditions of 13 vol % of O₂ inhalation is a threshold one, when ventilation (SpO₂) drops below 85%. A significant increase in the lung ventilation (Ve) (10–14%, p < 0.05) and HR (11–15%, p < 0.05) have been observed in this case. Hyperpnea was accompanied by an increase in the oxygen uptake rate by 10% and carbon dioxide release rate (10–18%, p < 0.05). On the contrary, individual data analysis showed changes in the pulmonary gas exchange indices in 90% of subjects in the case of inhalation of 17 vol % of O₂ HAM. Four response types have been found: ventilation (increase in lung ventilation), hypoxic hypometabolism (decrease in oxygen consumption rate), and mobilization response (increase in oxygen utilization in the lungs), and anaerobic response, which is expressed in an increase in the carbon dioxide release rate along with an increase in the respiratory quotient. All these responses are of an individual type, but the ventilation response is developed in response to hypoxia caused by inhalation of 13 vol % of O₂ HAM and a decrease in SpO₂ below 85% in more than 60% of cases.     

Action of PGI2 analogs on the pulmonary and systemic circulations in the conscious newborn lamb

Previous work (Lock , J. Pharm. Exp. Ther. :156, 1980) has shown that conventional screening procedures for vasoactive PGI₂ analogs have little value in predicting pulmonary vasodilator activity in the newborn lamb. To gain a better insight into the structural requirements for pulmonary vasoactivity and possibly identify useful compounds for the management of neonatal pulmonary hypertensive disorders, we have tested the following PGI₂ analogs in normoxic and hypoxic newborn lambs: 15(S)-9-deoxy-15-methyl1–9α, 6-nitrilo-PGF₁ (analog I); 9-deoxy-9α, 5-nitrilo-PGF₁ (analog II); (6S, 15S)-15-methyl-PG1₁ (analog III); and (6R, 15S)-15-methyl-PGI₁ (analog IV). A prostaglandin analog mimicking PGI₂ (compound BW245C; (±)-5-(6-carboxyhexyl)-1-(3-cyclohexyl-3-hydroxypropyl)hydantoin) was tested as well. Compounds were injected into a branch pulmonary artery and any local pulmonary effect could be assessed from the change in the ratio of blood flow to the injected lung over total flow. None of the analogs tested proved to be a selective pulmonary dilator. BW245C was a potent peripheral vasodilator (threshold around 0.5 μg/kg) and indirectly lowered pulmonary vascular resistance through its systemic effects. Analog I also dilated the systemic circulation, but only at the highest dose tested (100 μg/kg). The latter finding is surprising because it was previously shown that the parent, non-methylated compound is a fairly potent and selective pulmonary vasodilator. Analog II and IV were inactive at a dose up to, respectively, 30 and 20 μg/kg. Analog III, on the other hand, weakly constricted the systemic circulation at a dose of 10 μg/kg. These findings suggest that the neonatal pulmonary vasculature is endowed with specific receptor sites which can discriminative between closely related PGI₂ analogs.     

Pulmonary aspergillosis due toAspergillus terreus combined with staphylococcal pneumonia and hepatic candidiasis

A female patient with systemic lupus erythematosus (SLE) developed pulmonary aspergillosis with staphylococcal pneumonia and hepatic candidiasis.Aspergillus terreus, which is a rare causative organism of pulmonary aspergilosis, was identified from a pulmonary lesion by culture. The aleurioconidium production, a characeristic of the genusAspergillus sect.terrei, was demonstrated on short and irregular hyphal features in tissue sections. This report is the first of a combined case of pulmonary aspergillosis due toA. terreus with infections caused by other microorganisms.     

Different metastatic modes of malignant melanoma implanted in the ear of young and old mice

Summary An attempt has been made to determine (a) whether aging plays an important role in resistance against metastasis and (b) whether dithiothreitol, an effective in vitro mitogenic potentiator of splenic cells of young and old mice, can modulate the occurrence of pulmonary metastasis. B16-F10 melanoma cells were injected into the outer ear of young and old female C57BL/6 mice; and the growth of the primary tumor, the palpable size of the cervical lymph node, and the number of lung metastases were then determined at various intervals. The ear was amputated when the primary tumor reached 4 mm in mean diameter. The following results were obtained. (a) The growth rate of the primary tumor in young mice is comparable to that in old mice. (b) Enlargement of the cervical lymph node occurs earlier in old than in young mice. (c) Old mice are more vulnerable to pulmonary metastases, but small metastasized pulmonary colonies are more prominent in old than in young mice. (d) Dithiothreitol (100 g) injected every 2 days after the inoculation of tumor cells is effective in reducing the incidence of pulmonary metastases in old mice.     

In vivo hippocampal microdialysis reveals impairment of NMDA receptor–cGMP signaling in APPSW and APPSW/PS1L166P Alzheimer’s transgenic mice

Transgenic (Tg) mice overexpressing human amyloid precursor protein (APP) mutants reproduce features of early Alzheimer’s disease (AD) including memory deficit, presence of β-amyloid (Aβ) oligomers, and age-associated formation of amyloid deposits. In this study we used hippocampal microdialysis to characterize the signaling of N-methyl-d-aspartic acid receptors (NMDA-Rs) in awake and behaving AD Tg mice. The NMDA-R signaling is central to hippocampal synaptic plasticity underlying memory formation and several lines of evidence implicate the role of Aβ oligomers in effecting NMDA-R dysfunction. CA1 NMDA-Rs were stimulated by NMDA infused through reverse microdialysis while changes in the cyclic guanosine monophosphate (cGMP) concentration in the brain interstitial fluid (ISF) were used to determine NMDA-Rs responsiveness. While 4 months old wild type C57BL/6 mice mounted robust cGMP response to the NMDA challenge, the same stimulus failed to significantly change the cGMP level in 4 and 15 months old APP_SW and 4 months old APP_SW/PS1_L166P Tg mice, which were all on C57BL/6 background. Lack of response to NMDA in AD Tg mice occurred in the absence of changes in expression levels of several synaptic proteins including synaptophysin, NR1 NMDA-R subunit and postsynaptic density protein 95, which indicates lack of profound synaptic degeneration. Aβ oligomers were detected in all three AD Tg mice groups and their concentration in the hippocampus ranged from 40.5 ± 3.6 ng/g in 4 months old APP_SW mice to 60.8 ± 15.9 ng/g in 4 months old APP_SW/PS1_L166P mice. Four months old APP_SW mice had no Aβ amyloid plaques, while the other two AD Tg mice groups showed evidence of incipient Aβ amyloid plaque formation. Our studies describes a novel approach useful to study the function of NMDA-Rs in awake and behaving AD Tg mice and demonstrate impairment of NMDA-R response in the presence of endogenously formed Aβ oligomers but predating onset of Aβ amyloidosis.     

Mechanism of A23187-induced airway obstruction in the guinea pig

Exposure of conscious guinea pigs to A23187 aerosol produced a concentration-related increase of excised lung gas volume (ELGV), . ., postmortem pulmonary gas trapping. Measurements of ELGV were highly correlated with measurements of dynamic compliance (C_dyn) and total pulmonary resistance (R_L) and were used as an indication of airway obstruction. We pretreated guinea pigs intravenously with the following drugs: atropine; LY163443, a selective LTD₄/E₄ antagonist; indomethacin; propranolol; and pyrilamine. The guinea pigs were exposed for 8 minutes to the A23187 aerosol, and ELGV measurements were then made. Atropine or pyrilamine prevented the A23187-induced gas trapping. Indomethacin or propranolol tended to potentiate the response and when combined, they potentiated the gas trapping by 80%. LY163443 had no effect alone, but when combined with indomethacin, propranolol, and pyrilamine, inhibited A23187-induced gas trapping by 67%. We conclude that cholinergic and histaminergic mechanisms play major roles in the ionophore-induced pulmonary gas trapping of the guinea pig. With appropriate pretreatment, sulfidopeptide leukotrienes may produce a substantial effect.